BMT Survivor Study-2 (BMTSS-2)

PROJECT SUMMARY / Abstract: The latest threat to global health is the ongoing outbreak of the respiratory disease named Coronavirus Disease2019 (Covid-19). Covid-19 is highly transmissible, causes relatively high mortality, and has spread globally inour highly interconnected world. As of 4/26/2020, in the US alone there were 963,168 confirmed COVD-19 casesand 54,614 reported deaths due to COVID-19, and the curve demonstrating cumulative cases shows noevidence of a plateau. The case-fatality rate in the US is currently ~5%, and there is emerging evidence that theelderly and those with underlying comorbidities are at higher risk of succumbing to COVID-19-relatedcomplications. Importantly, there is no information about susceptibility to this infection among other vulnerablepopulations, such as those with prolonged immune suppression after blood or marrow transplantation (BMT).BMT survivors are likely at higher risk for COVID-19 infection that the general population for the followingreasons: i) as part of the conditioning for BMT, patients are exposed to high doses of chemotherapy andradiation; ii) BMT has been increasingly offered to older adults and BMT survivors are aging; iii) BMT survivorsare at a higher risk of comorbidities (diabetes, hypertension, coronary artery disease, and heart failure); and iv)~40% of the allogeneic BMT recipients develop chronic graft versus host disease (GvHD), and receive immunesuppressive therapy to manage the GvHD for prolonged periods of time. The risk of COVID-19 infection and ofCOVID-19 infection-related complications as well as case-fatality rate in BMT survivors are not known. Thecontribution of comorbidities to COVID-related complications in BMT survivors is also unknown. We will addressthese gaps using a large cohort of allogeneic BMT survivors (n=2,060) who have already participated in BMTSS-2 (parent study U01CA213140, PI, Bhatia). These patients were transplanted between 1974 and 2014, at oneof 3 participating sites (UAB, COH or UMN) and survival of ≥2y after BMT. As a result of their participation, wenow have information on their sociodemographics, clinical characteristics and burden of morbidity. We have alsoenrolled a cohort of 1,150 non-cancer individuals to serve as a comparison group. We will use this rich resourceto A) Describe the risk of COVID-19 infection in allogeneic BMT survivors compared to controls; B) Amongparticipants with COVID-19 infections, compare the prevalence of severe complications in BMTSS-2 survivorswith controls; C) Describe the prevalence of financial and psychosocial distress among BMT recipients comparedto the controls; D) Identify BMT recipients at highest risk for COVID-19 infection and severe complications. Thiscohort will represent the largest and most comprehensive attempt at examining the health and wellbeing of BMTrecipients during the COVID-19 pandemic. Findings from this study will have direct relevance for prevention fromCOVID-19 infection of not only the high risk BMT recipients, but also other individuals with a compromisedimmune system.